Patient-Centered Communication: Basic Skills

 

Communication skills needed for patient-centered care include eliciting the patient's agenda with open-ended questions, especially early on; not interrupting the patient; and engaging in focused active listening. Understanding the patient's perspective of the illness and expressing empathy are key features of patient-centered communication. Understanding the patient's perspective entails exploring the patient's feelings, ideas, concerns, and experience regarding the impact of the illness, as well as what the patient expects from the physician. Empathy can be expressed by naming the feeling; communicating understanding, respect, and support; and exploring the patient's illness experience and emotions. Before revealing a new diagnosis, the patient's prior knowledge and preferences for the depth of information desired should be assessed. After disclosing a diagnosis, physicians should explore the patient's emotional response. Shared decision making empowers patients by inviting them to consider the pros and cons of different treatment options, including no treatment. Instead of overwhelming the patient with medical information, small chunks of data should be provided using repeated cycles of the “ask-tell-ask” approach. Training programs on patient-centered communication for health care professionals can improve communication skills.

The Institute of Medicine identified patient-centered care as one of six elements of high-quality health care.1 A patient-centered approach to care is based on three goals13: eliciting the patient's perspective on the illness, understanding the patient's psychosocial context, and reaching shared treatment goals based on the patient's values. Patient-centered care builds on discussions and decisions that involve shared information, compassionate and empowering care provision, sensitivity to patient needs, and relationship building.3 In contrast to a disease-focused biomedical approach, patient-centered care considers patient preferences, needs, and values, ensuring that they guide all medical decisions in tandem with scientific evidence.1 Although most patients (about 70%) prefer patient-centered communication, it is difficult to predict preferences for an interviewing style (patient-centered vs. disease-focused) based on the patient's age, sex, or ethnicity.4  This article provides an overview of patient-centered communication techniques for physicians. Table 1 outlines a sequence for medical interviewing that incorporates patient-centered elements.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferencesComments

Physicians should avoid interrupting the patient early in the interview.

B

7, 8

Observational studies

Physicians should elicit the patient's agenda early in the interview until all concerns have been expressed. The phrase “Is there something else?” is preferred over “Is there anything else?”

B

9

One randomized controlled trial

Training programs, even those of short duration (less than 10 hours), generally improve physicians' patient-centered communication skills.

A

20, 23

43 randomized controlled trials

Training on patient-centered communication combined with disease-specific materials may improve patient outcomes.

B

20

Less than 20 trials with mixed results; effect size was smallest for health outcomes

Patient-centered care is an intrinsically desirable health care priority regardless of its effect on clinical outcomes.

C

26

Expert opinion


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferencesComments

Physicians should avoid interrupting the patient early in the interview.

B

7, 8

Observational studies

Physicians should elicit the patient's agenda early in the interview until all concerns have been expressed. The phrase “Is there something else?” is preferred over “Is there anything else?”

B

9

One randomized controlled trial

Training programs, even those of short duration (less than 10 hours), generally improve physicians' patient-centered communication skills.

A

20, 23

43 randomized controlled trials

Training on patient-centered communication combined with disease-specific materials may improve patient outcomes.

B

20

Less than 20 trials with mixed results; effect size was smallest for health outcomes

Patient-centered care is an intrinsically desirable health care priority regardless of its effect on clinical outcomes.

C

26

Expert opinion


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion,

The Author

M. JAWAD HASHIM, MD, is an associate professor of family medicine at the United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi.

Address correspondence to M. Jawad Hashim, MD, United Arab Emirates University, Tawam Hospital Campus, P.O. Box 17666, Al Ain, Abu Dhabi, 17666 (e-mail: physicianthinker@gmail.com). Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

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